Provider Demographics
NPI:1952802431
Name:BAGLEY, AMY JOY (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JOY
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1253
Mailing Address - Country:US
Mailing Address - Phone:585-317-8839
Mailing Address - Fax:
Practice Address - Street 1:245 EAST ST
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1253
Practice Address - Country:US
Practice Address - Phone:585-317-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse